1. Position of the primary care in the care for elderly in Slovakia Peter Liptak, Iveta Vaverkova, Jana Bendova, Peter Pekarovic Slovak Society of General Practice SkMA EFPC Conference Pisa 31.08.2010 www.vpl.sk

2. Slovakia

3. PNEUMPNEUMOLÓGISTOLÓGISTPNEUMPNEUMOLÓGISTOLÓGIST INTERNISTINTERNISTINTERNISTINTERNIST GERIATRICIANGERIATRICIANGERIATRICIANGERIATRICIAN A LL E R G O L O G I ST PSYCHIATR PPSSYYCCHHIIAATTRRISTISTPPSSYYCCHHIIAATTRRISTIST CAR CCAARRDIDIOOLLÓGÓGIISSTTCCAARRDIDIOOLLÓGÓGIISSTTOLIST Fate of chronic polymorbid elderly patient in Slovakia Fate of chronic polymorbid elderly patient in Slovakia GP - P H C - GP - P H C - NEUROLÓGIST DIABETOLÓGIST INFECTOL IINNFFEECCTTOOLLÓGÓGIISSTTIINNFFEECCTTOOLLÓGÓGIISSTTIST... Chronic polymorbid elderly patient SPECIALISTS – DISPENSARISATION CARE This patient is early exhausted. In the best case he ends up in a good private institution for elderly - outside of community. Too expensive and inefficient care. Insufficient public health care. ☻ no power (no competences) no power (no competences)

4. ? in how far do geriatricians/specialists in elderly care operate in primary care? Do they assist/train GP's, do they operate in parallel to GP's? a ? in how far do geriatricians/specialists in elderly care operate in primary care? Do they assist/train GP's, do they operate in parallel to GP's? They operate in parallel to GPs, They have competences, but they don´t operate in community in primary care. There is a meaningful coordination with GPs missing Coordination is assured via transporting patients to geriatricians/specialists offices with ambulances or otherwise. Often, this process employs the whole family... ? home visits by GP's, nurses and other health workers in order to prevent or recognize early deterioration of the health of elderly people? b ? home visits by GP's, nurses and other health workers in order to prevent or recognize early deterioration of the health of elderly people? The number of GP´s home visits is reduced. Home visits are not supported by payments from insurance companies neither by policy of health care system. GP without competences in his office isn´t motivated to provide homecare. Nurses do the home visits rarely. In the past - one GP used to have 2 nurses – one for home visits. This system is not supported anymore. Independent home nursing care agencies operate in the community with limited competencies, human as well as financial recouces. ? prevention of falls at home (falls are an important cause of disability and dependence) - does primary care play a role? c ? prevention of falls at home (falls are an important cause of disability and dependence) - does primary care play a role? Identical with b) Pim´s questions...

5. Primary care as a hub of coordination? Private institutions for elderly are trendy... outside of community, outside of PHC... expensive – ineffective - insufficient SLOVAKIA Politicians prefer business/market models in healthcare for elderly...

6. XXXI. Annual conference in Bojnice 21 – 23 October 2010 We are inviting you... This troubleshooting requires a very entusiastic people

7. Thank you for your attention!